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Passing dark urine with abdominal pain. Blood test done. Diagnosed with gall stones. Required treatment?

Apr 2013
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General Surgeon
Practicing since : 2008
Answered : 9335 Questions
I have experienced abdominal pain over the last 8 days. I visited the doctor following the observation of passing of dark urine at all timepoints during the day over the last few days. The doctor ordered blood tests which as follows ;
Alkaline phosphatase 151 (30-120); total bilirubin 103 umol/L (3-20); AST 579 (10-50) and GGT 959 (5-55). My alcohol intake is moderate (< 25 units per week) and has not changed over a number of years. During this timeperiod my blood has been checked on a periodic basis and the GGT values have ranged between 34-40 U/L. The doctor has provisonally diagnosed gall stones but I require a detailed radiological scan. I am concerned about the magnitude of the GGT increase since I do not consider this related to alchol intake which was suggested. My pattern of alcohol intake is not to drink at least 3-4 days during the week. What do you think about the GGT increase?
Posted Tue, 5 Mar 2013 in Liver and Gall Bladder
Answered by Dr. Ivan R. Rommstein 1 hour later

This is a picture of bile duct obstruction, but also a sign of liver damage which can be acute or chronic. First of all you dont need to be worried if you have only these symptoms you have said ,just need to do few more tests to evaluate liver morphology.

The most people think that GGT is indicator of alcohol abuse but increased levels of GGT levels may indicate in general that the liver is being damaged but does not specifically point to a condition that may be causing the injury.
It can be viral or alcoholic hepatitis, bile duct disorders or autoimmune liver diseases, congestive heart failure. Even smoking elevates GGT. Also if you have been alcohol drinking before blood test it also elevates its level.

Usually ALP indicates bile duct obstruction, but you have so typical symptoms that it is obvious that you have gallbladder stones. These stones obstruct ducts and cause retrograde liver damage.They usually passes through the duct but sometimes get stuck and then cause problems. This is probably mechanism of your enzymes elevation. But dont forget that this damage can be combined with other causes of liver damage which i ve mentioned before. To evaluate this you should do liver ultrasound or CT scan and see is there any sign of cirrhosis which can mean some more serious diseases that I wont mention.
If only stones are found then the cholecystectomy or endoscopic stones removal need to be done. These are simple procedures.

Also GGT elevation isnt the same in every person. Some livers, depending on genetics, are more sensitive to alcohol abuse.

Hope i am helpful. If you have any questions let me know.
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